Provider Update 6/6/08

Rationale:

The existing PNMI authorization process for children authorized for placement by DHHS-Children’s Behavioral Health Services (CBHS) requires a 2-part authorization.  APS Healthcare authorizes MaineCare treatment and CBHS UR Nurses authorize the Room and Board portion of the PNMI reimbursement.  This divided authorization process is cumbersome and inefficient for providers, DHHS and APS Healthcare.  CBHS and APS Healthcare are committed to improving system efficiency.  As a result, the authorization processes for PNMI MaineCare treatment and CBHS approved Room and Board reimbursement will be integrated into a single authorization process with APS Healthcare.

Please Note: 

• This revised process only applies to CBHS approved PNMI placements.  It does not apply to PNMI placements authorized by Child Welfare caseworkers (including Treatment Foster Care), Adult Mental Health Services or Substance Abuse PNMI placements. 
• Only CBHS Approved PNMI Placements may bill for room and board using the BR procedure code.  It is considered fraud if a provider bills with the BR code without CBHS approval.
• All references below to “Room & Board” authorizations refer only to CBHS-Approved PNMI Placements.

Revised Process:

• The Room & Board procedure code is:  BR
• Starting July 1, 2008, PNMI providers must request the Room & Board procedure code at the time that they request the RTS code.
• For children in PNMI service prior to 7/1/08, providers must submit a registration for the BR code to obtain authorization.
• For children admitted to PNMI 7/1/08 and after, providers must request both the RTS and BR procedure codes at the registration and each subsequent review.
• All Room & Board authorizations created by CBHS are valid only through 6/30/08.